What this guide helps with
Insurance rules for hearing care can feel inconsistent because plans often treat hearing tests differently than hearing devices. This page explains the usual patterns for Medicare, Medi-Cal, private insurance, and VA benefits—and gives you a simple script for calling your plan to confirm coverage.
Understanding how to pay for hearing care can be confusing, especially for older adults. This guide helps you navigate health insurance coverage for hearing tests, hearing aids, and related services in California.
We’ll explain key differences (like medical exams vs. hearing devices), summarize how Medicare, Medi-Cal, private insurance, and Veterans Affairs (VA) benefits handle hearing care, and give you tips on checking your coverage.
Medical diagnostics vs. hearing devices
The most important thing to know is that insurance companies often separate “medical care” from “hearing devices.”
- Medical diagnostic services: Many plans cover diagnostic testing (like a doctor-ordered hearing exam) to find the cause of hearing loss, dizziness, or balance issues. Medicare Part B and Medi-Cal typically cover these as medical services [2].
- Hearing devices (treatment): Coverage for hearing aids varies widely. Many plans classify hearing aids as “elective.” For example, Original Medicare does not cover hearing aids or exams for fitting them [4].
Quick comparison: what plans usually cover
| Coverage type | Diagnostic hearing test | Hearing aids | Notes you should confirm |
|---|---|---|---|
| Original Medicare (A/B) | Often covered when ordered to evaluate a medical condition [2] | Generally not covered [4] | Referral/order requirements; cost-sharing; which test codes apply |
| Medicare Advantage (Part C) | Usually covered; rules vary by plan [7] | Often some benefit (allowance or network discount) [7] | Allowance amount, frequency, network restrictions, prior auth |
| Medi-Cal | Typically covered | Covered within program rules/caps [8] | Annual cap, what “counts” toward it, batteries vs. repairs |
| Private insurance | Often covered if medically necessary | Highly variable [19] | Dollar max, “benefit period,” in-network requirements, exclusions |
| VA benefits | Covered for eligible Veterans | Often provided at no cost for eligible Veterans [25] | Enrollment eligibility; local process for audiology access |
Medicare coverage
Medicare is federal health insurance primarily for people age 65+. It is important to know the difference between Original Medicare and Medicare Advantage plans.
Original Medicare (Parts A & B)
Original Medicare generally does not cover hearing aids or exams for fitting hearing aids. You may pay these costs out-of-pocket [4]. Part B may cover diagnostic exams when ordered by a clinician to evaluate a medical condition [2].
Medicare Advantage (Part C)
These are private plans that bundle Medicare benefits. Many Advantage plans offer extra benefits that Original Medicare doesn’t [7].
- Some plans offer an allowance (for example, $500 or $1,000) toward hearing aids every few years.
- Others provide specific models at a reduced cost if you use their network providers.
- Action item: check your plan’s “Summary of Benefits” and “Evidence of Coverage.”
Medi-Cal (California Medicaid)
Medi-Cal covers a range of hearing care services for eligible residents, but there are specific rules.
The annual hearing aid cap
As of 2025, the benefit for hearing aids is capped at $1,510 per person each fiscal year (July 1 – June 30) [8]. This may cover one basic hearing aid (or two very basic models). Higher-end devices often cost more than the cap.
What is included? The cap may include hearing aids, ear molds, and supplies. Repairs may also be covered within cap limits [11]. Replacement batteries are generally not covered for adults.
Private health insurance
Coverage under private insurance (employer or individual plans) is highly variable. While California mandates some coverage in certain cases, it often comes with conditions.
- Hearing tests: many plans cover diagnostic exams when medically necessary.
- Hearing aids: some plans offer a fixed dollar amount (for example, $500 every 3 years), while others offer negotiated discounts [19].
- Where to look: search your plan documents for “Audiology,” “Hearing Services,” “Hearing Aids,” or “Durable Medical Equipment.”
Veterans Affairs (VA) benefits
Strong coverage for eligible Veterans
The VA is one of the best sources for hearing healthcare. If you are enrolled in VA health care and eligible, the VA may furnish hearing aids, batteries, and repairs at no cost to you [25].
You generally do not need a service-connected disability specifically for hearing to receive hearing aids, as long as you are enrolled in VA health care and the aids are clinically indicated.
How to check your coverage
Before your appointment, call your insurance provider. Use the script below to make sure you ask the right questions.
Phone script: coverage check
“Hello, I’m calling to ask about my coverage for hearing services.”
1) Is the diagnostic hearing test covered? (Common code: 92557)
2) Are hearing aids covered? (Common code: V5261)
3) If yes, is there a dollar maximum or allowance? How often (every year / every 3 years)?
4) Do I need prior authorization or a referral?
5) Must I use specific in-network providers or a designated vendor?
Appeals and denials
If your insurance denies a claim, you have the right to appeal [31].
- Prior authorization: always confirm whether it’s required before receiving services or devices.
- Internal appeal: submit a letter with clinician notes explaining why the device or service is medically necessary.
- External review: if the internal appeal fails, an independent third party may be able to review the case.
Financial assistance options
If you lack coverage (or your coverage is limited), consider these alternatives:
- Payment plans: CareCredit or clinic-specific installment plans.
- Nonprofits: organizations like the Starkey Hearing Foundation, Lions Clubs, or Audient Alliance [19].
- Department of Rehabilitation: if you are working, they may help cover costs to support job function.
- Over-the-counter (OTC) hearing aids: for perceived mild-to-moderate loss, OTC options may reduce cost (confirm return policies and support).
The bottom line
Insurance coverage for hearing care is often split: diagnostic testing is more commonly covered than hearing aids. Verify benefits before you schedule, especially network rules and prior authorization.
If you’re eligible for VA or Medi-Cal, those programs may offer meaningful support. If private coverage denies a claim, consider an appeal.
Glossary of terms
- Deductible
- The amount you pay out-of-pocket before your insurance starts to pay.
- Copayment (copay)
- A fixed amount (for example, $20 or $50) you pay for a covered service.
- Prior authorization
- Approval from the insurance plan that is required before you get a service or device.
- In-network
- Providers who contract with your plan. Visiting them is usually cheaper than out-of-network providers.
References & resources
- [2] Medicare.gov: Hearing & balance exams
- [4] Medicare.gov: Hearing aid coverage
- [7] Medicare Advantage coverage varies by plan. Review your plan’s “Summary of Benefits” and “Evidence of Coverage.”
- [8] DHCS: Medi-Cal Hearing Aid Cap FAQ (2025)
- [11] Medi-Cal provider guidance for hearing aid repairs (confirm current policy through DHCS / plan materials).
- [19] Healthy Hearing: Insurance & financial assistance
- [25] VA Rehabilitation and Prosthetic Services: Audiology
- [31] HealthCare.gov: How to appeal an insurance decision